Healthcare Provider Details

I. General information

NPI: 1104515006
Provider Name (Legal Business Name): OLUFEMI OGUNLANA I SOLE PROPRIETOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 GELBRAY DR
OBETZ OH
43207-4998
US

IV. Provider business mailing address

1087 GELBRAY DR
OBETZ OH
43207-4998
US

V. Phone/Fax

Practice location:
  • Phone: 614-230-5700
  • Fax:
Mailing address:
  • Phone: 614-230-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.500890
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.500890
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: